Doctors Who Make a Difference in Hawai‘i

Meet five Hawai‘i physicians that are doing important work in our local communities.

By Don Wallace, Katrina Valcourt and Ikaika Ramones

Published: 2015.09.28 12:20 PM

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Doctors have a noble calling. Whether they’re diagnosing a child’s allergy, setting a broken bone or excising a life-threatening brain tumor, they spend days and nights helping others. While it’s hard to single out only a few, we wanted to spotlight Hawai‘i physicians doing important work in our local communities. We found fascinating and heartwarming stories including doctors who are helping the blind see, trailblazing a new cancer drug made from noni, finding a neighborhood-level approach to fighting diabetes and more.

Finding Face

The first surgeon to do a face transplant has brought his transformative skills to Hawai‘i.

By Don Wallace

Dr. Daniel Alam won fame leading the first face transplant operation in the United States.

Photos: Olivier Koning

“I THINK IT WAS THE PINK FLOODING BACK IN,” says Dr. Daniel Alam when asked to describe the peak of his career to date.

Seven years ago, Alam orchestrated a team of 32 specialists for the first facial transplant in the United States. And, as lead micro-vascular surgeon, he personally removed the dying donor’s face, then carried it into the next room to sew it onto the recipient.

Alam had been up for 24 hours, in the operating suites for 16; he had to sew together blood vessels only two millimeters in diameter using sutures much finer than human hair. “If these vessels fail, this face will not survive,” he remembers thinking.

Alam stood frozen. “A moment before, I was holding a dead human face in my hands, a face fresh off the donor who was still technically alive, heart still pumping. Now I’d totally lost my confidence. The face was gray, inert; it couldn’t possibly come back to life.”

At that moment, he recalled what the patient who was to receive this face had said to him before she went under the anesthetic. Connie Culp had lost her face to a shotgun blast and had spent years as a recluse due to the frightened reactions of people she encountered. She couldn’t go to the store without a child shrieking and calling her a monster.

“If you weren’t the right person to be doing this, I wouldn’t be doing it,” she told him. “I know you will take good care of me.’”

And so Alam went to work. An hour later, primary vessels were done. “The moment of truth for the patient had arrived. I said a prayer to myself and released the vessel clamps,” he later wrote in his journal, which he shared with HONOLULU.

“As our patient’s blood began to flow into her new face, I witnessed a miraculous transformation. Life streamed into the ghostly façade. Within seconds, her lips became red, her skin became pink. I felt like our patient embraced this new face as her own.”

The success of the Cleveland Clinic transplant, and one Alam assisted on a few months later on a woman who had been mauled by a chimpanzee, vaulted him to the pinnacle of his profession. But the moment of doubt that preceded the triumph was equally important, Alam insists. It helped him make up his mind about where to go next: Hawai‘i.

“My personality has always led me to seek out the undiscovered country,” he says, “the field of knowledge where I can make my contribution.” He could go almost anywhere and write his own ticket. But, in Alam’s case, he found himself drawn to Hawai‘i because, “I discovered the acute need that existed in the Islands and throughout Micronesia for complex reconstructive surgery.”

INSTEAD OF GOING IN THE DIRECTION of more difficult and spectacular surgeries and transplants, he wanted to go where he was most needed by the most people. That meant pairing up with reconstructive surgeon Christopher Klem at the newly formed Head and Neck Institute of The Queen’s Medical Center and serving as clinical professor of surgery at the John A. Burns School of Medicine. “I’m backfilling a void that was not met here—people either were going to the Mainland or, if they lacked resources, would be offered suboptimal treatments.”

To this day, he says, the revelation during the face transplant surgery centers him. “If I’m taking a little mole off your face, then that’s the most important thing. I owe it to you to repay your faith in me in the best way possible.”

Alam describes himself as self-critical and process-minded, to the point that, years ago, he started videotaping himself doing microsurgery in order to critique his own work. His teaching at the medical school allows him to pass along a core truth.

“It’s not that you’re more gifted than other people, but how you think about problem solving, that allows you to do this. You have to see the failure in your successes to evolve.”- Dr. Daniel Alam

That’s what happened when he finished the 42 sutures needed to sew the face together, he says. “I saw that the result was still nowhere near as good as what came from the original factory.”

Living in Honolulu with his wife and two children suits Alam’s generous nature. “The beautiful thing about Hawai‘i is how people think here, the ‘ohana concept, it’s remarkable,” he says. “I’ve been at big institutions on the Mainland. There’s no talk story; it’s staccato, a much more structured relationship. Here, no matter what your social and financial status, the roles your aunties and uncles play allow complex things to happen. They don’t even have to be related by blood.”

And this, he says, rewards him as a surgeon. “Like when we had a complex reconstruction on this lady and there were 17 grandchildren in her post-operative waiting room. Those kinds of moments are really wonderful.”